Cursors in A show outline endometrial echo complex. This information may improve the selection of patients for ablation and may possibly steer improvements in technique. The evaluation of the endometrium and uterine cavity can be done both by TAS and TVS. However, adenomyosis was detected in the ablated specimens in six of these seven patients, and only one of the five patients without endometrial regeneration had adenomyosis. Long-term follow-up investigation [3] reported NovaSure to have better patient satisfaction, higher rates of amenorrhea [17, 20], and a lower occurrence of intraoperative and postoperative pain compared with the results of studies of thermal balloon ablation [20, 21]. The IETA (International Endometrial Tumor Analysis group) statement is a consensus statement that has been published by a panel of experts (IETA consensus group) for terms, definitions and measurements for describing and reporting the endometrium and its pathologies. [30], the most common site of residual endometrium on postablation MRI was the cornual regions and 18% of the patients with residual endometrium in the cornual regions also had cornual hematometra. By the end of menstruation, the endometrium is thin, about 1–4 mm in thickness. Magnification is important and the Doppler setting should be optimised to ensure maximal sensitivity for blood flow (details in the section on Doppler in Chap.

5 and 6).
For patients with menorrhagia, the treatment options include both medical therapy and surgery. Radiofrequency energy is then delivered through mesh to ablate endometrium and superficial myometrium. Radiology. These polyps are often visualised well on 3D rendered coronal images of the uterine cavity. Radiologists should recognize the normal imaging findings in patients who have undergone endometrial ablation, be aware of the causes of treatment failure, and accurately identify delayed complications associated with these procedures. Adenomyosis was identified in 43% of patients [43]. 3A —42-year-old woman who presented with recurrent dysmenorrhea and abnormal uterine bleeding 1 year after ablation. The “Misty Mesentery”: Mesenteric Panniculitis and Its Mimics, Review. OBJECTIVE. The most commonly used imaging modality for evaluating the endometrium is pelvic ultrasound with transabdominal and transvaginal techniques. Fetal anatomy and uterine anatomy can be further assessed with MRI if clinical questions remain after ultrasound examination (Fig. 2). Turnbull et al. 2001;220 (3): 765-73. 4. At the time of administrating the hCG injection in women undergoing follicular imaging for infertility, the endometrial thickness should be at least 6 mm, and the results are best when the thickness is 8 mm. 4A —50-year-old woman who presented 2 months after ablation with persistent pelvic pain (same patient as Fig. For radiologists to better assist the clinician in the management of these patients, ultrasound and particularly MRI can be helpful in isolating cornual hematometra and a diagnosis of PATSS, which often require hysterectomy for definitive management. Before ablation, endometrial sampling is performed in all women to exclude endometrial hyperplasia and endometrial cancer, which are contraindications for endometrial ablation. Polyps could be multiple, each with its individual feeder vessel. HHS NIH However, a f eeding vessel was not visualized on color Doppler imaging. [Article in German] Abu Hmeidan F(1), Bilek K, Baier D, Nuwayhid M, Kade R. Author information: (1)Frauenklinik des Universitätsbereiches Medizin, Universität Leipzig. Fig. [33] have reported widening of the junctional zone immediately after ablation that persisted at 3 months in some patients. The endometrial thickness may decrease minimally at ovulation, but after that it increases gradually in thickness (7–15 mm). The echogenicity is termed non-uniform, if the endometrium appears heterogeneous, asymmetrical or cystic. Fig. A, Axial T1-weighted image shows central hyperintensity (arrow) consistent with presence of blood products. Endometrial ablation does not prevent future pregnancy, and pregnancy after ablation is often associated with complications [8–10]. By continuing you agree to the use of cookies. On Doppler, a dominant vessel (‘feeder vessel’/‘pedicle artery sign’) is seen approaching the polyp from the adjoining myometrium across the EMJ. Fig. Fig. Radiologists must be familiar with ablation techniques, the expected imaging appearances of the uterus after ablation, and the potential delayed complications that may arise. Many pregnancy-related complications can be explained by the morphologic changes that the intrauterine cavity undergoes after endometrial ablation, including the development of scarring, adhesions, synechiae, and contracture [46, 47]. The relative contraindications include postmenopausal status, congenital uterine anomalies, large uterine cavity size, severe myometrial thinning from prior myomectomy, and tamoxifen therapy. Endometrium in different phases of menstrual cycle. 2A —50-year-old woman who presented 2 months after ablation with unremitting pelvic pain, which eventually led to hysterectomy. D'autres méthodes d'imagerie peuvent également être employées, notamment l'hystéro-échographie et l'imagerie par résonance magnétique. Second, we will discuss the expected imaging appearance of the postablation uterus and review the pathologic basis for the imaging findings of delayed complications after endometrial ablation. Endometrial cancer is often detected at an early stage because it frequently produces abnormal vaginal bleeding. L’échographie du bassin (avec recours à des techniques transabdominales et transvaginales) est la modalité d'imagerie la plus souvent utilisée pour évaluer l'endomètre. Hyperechoic small polyp in a proliferative endometrium, Hyperechoic polyp clearly visualised in a proliferative endometrium.


Please note that these measurements are a guide only, as endometrial thickness may be variable from individual to individual. 2A —50-year-old woman who presented 2 months after ablation with unremitting pelvic pain, which eventually led to hysterectomy. Destruction of the endometrial lining by resectoscopic or nonresectoscopic endometrial ablation techniques results in the clinical improvement of menorrhagia symptoms for most women; however, it also results in changes that eventually lead to the development of delayed complications in some patients. Central hematometra—Central hematometra occurs as a result of obstructed bleeding from residual or regenerating endometrium in the setting of lower uterine segment or cervical stenosis caused by injury to these regions during the ablation. D&C biopsy for histopathology assessment. 2). One study showed that symptomatic patients tend to have a greater mean endometrial thickness than asymptomatic patients (6.0 vs 5.2 mm, respectively), although this difference is not statistically significant [27]. In this prospective study 571 patients with postmenopausal bleeding/discharge (group I) and 300 patients without symptoms (group II) were ultrasonographically examined. 7. (Drawings by Sakala M). Findings are consistent with postablation tubal sterilization syndrome. Endometrial echo complex measured 3.1 mm. MRI will play a greater role in postablation patients with suspected endometrial cancer given its inherent advantages over ultrasound. 7 and 8). Cursors in A show outline endometrial echo complex. A transvaginal ultrasound (TVUS) is often better to look at the uterus.

At the onset of puberty, the endometrium gradually increases in thickness and becomes like that of an adult. Keywords: endometrial ablation, endometrial cancer, hematometra, imaging, menorrhagia, postablation tubal sterilization syndrome, pregnancy.